[Show abstract][Hide abstract] ABSTRACT: The fifth edition of the Diagnostic and Statistical Manual includes a dissociative subtype of posttraumatic stress disorder, but no existing measures specifically assess it. This article describes the initial evaluation of a 15-item self-report measure of the subtype called the Dissociative Subtype of Posttraumatic Stress Disorder Scale (DSPS) in an online survey of 697 trauma-exposed military veterans representative of the U.S. veteran population. Exploratory factor analyses of the lifetime DSPS items supported the intended structure of the measure consisting of three factors reflecting derealization/depersonalization, loss of awareness, and psychogenic amnesia. Consistent with prior research, latent profile analyses assigned 8.3% of the sample to a highly dissociative class distinguished by pronounced symptoms of derealization and depersonalization. Overall, results provide initial psychometric support for the lifetime DSPS scales; additional research in clinical and community samples is needed to further validate the measure.
[Show abstract][Hide abstract] ABSTRACT: Ecologically valid typologies of adverse child experiences (ACEs) were identified to investigate
the link between ACEs and adult incarceration. In a nationally representative sample (N=34,653,
age 20+), latent class analysis (LCA) was conducted with childhood maltreatment [physical,
sexual, and emotional abuse, interpersonal violence (IPV) exposure, physical neglect] and
caregiver maladjustment (substance use, incarceration, mental illness, suicidal behavior)
indicators. LCA identified a 5-typology model (1. Low Adversity Risk, 2. Caregiver Substance
Use, and Maltreatment Acts of Omission, 3. Physical and Emotional Maltreatment, 4. Severe
Cross-Subtype Maltreatment and Caregiver Substance Use, and 5. Caregiver Maladjustment).
Controlling for sociodemographics and substance use problems, logistic regression analyses
determined that, compared to the Low Adversity Risk typology, all typologies (except Caregiver
Maladjustment) had elevated incarceration risk (adjusted odds ratios: 1.76-4.18). Maltreatment
experiences were more predictive of incarceration for females vs. males. Childhood
maltreatment confers risk for incarceration beyond established risk factors, but caregiver
maladjustment, alone, does not. Preventative efforts should focus on understanding and targeting
pathways to delinquency for individuals with childhood maltreatment.
American Journal of Orthopsychiatry 10/2015; · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although most resilience science has focused on individual-level psychosocial factors that promote individual resilience, theorists and researchers have begun to examine neurobiological and systems-level factors implicated in resilience. In this commentary we argue that the development of effective interventions to enhance resilience necessitates understanding that resilience in the individual is dependent on multiple layers of society. Further, we suggest that there is a bidirectional relationship between systems-level resilience (i.e., resilience of romantic partners, family members, neighborhoods, and larger social contexts) and individual resilience. We suggest directions for future research and interventions, with the goal of stimulating research efforts that address these questions among trauma-exposed individuals.
ECOLOGY AND SOCIETY 10/2015; 20(4):10. DOI:10.5751/ES-07832-200410 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Typologies of DSM-5 PTSD symptoms and personality traits were evaluated in regard to coping styles and treatment preferences using data from 1266 trauma-exposed military veterans of which the majority were male (n=1097; weighted 89.6%). Latent profile analyses indicated a best-fitting 5-class solution; PTSD asymptomatic and emotionally stable (C1); predominant re-experiencing and avoidance symptoms and less emotionally stable (C2); subsyndromal PTSD (C3); predominant negative alterations in mood/cognitions and combined internalizing-externalizing traits (C4); and high PTSD severity and combined internalizing-externalizing traits (C5). Compared to C5, C1 members were less likely to use self-distraction, denial, and substance use and more likely to use active coping; C2 and C4 members were less likely to use denial and more likely to use behavioral disengagement; C3 members were less likely to use denial and instrumental coping and more likely to use active coping; most classes were less likely to seek mental health treatment. Compared to C1, C2 members were more likely to use self-distraction, substance use, behavioral disengagement and less likely to use active coping; C3 members were more likely to use self-distraction, and substance use, and less likely to use positive reframing, and acceptance; and C4 members were more likely to use denial, substance use, emotional support, and behavioral disengagement, and less likely to use active coping, positive reframing, and acceptance; all classes were more likely to seek mental health treatment. Emotional stability was most distinguishing of the typologies. Other implications are discussed.
[Show abstract][Hide abstract] ABSTRACT: Background:
Posttraumatic growth (PTG) is commonly observed among trauma survivors. However, few studies have treated PTG as multi-dimensional and examined how different PTG dimensions may be protective against the negative effects of future trauma.
Using a nationally representative web-based survey of 1057 U.S. military veterans followed for two years, we examined whether different PTG dimensions had a protective effect on the severity and diagnosis of posttraumatic stress disorder (PTSD) in the face of new traumatic life events.
Greater scores on the Personal Strength domain of the PTG Inventory-Short Form at baseline was associated with reduced severity (β=-.05, p<.05) and incidence (OR=.68, 95% CI=.50-.93) of PTSD at a two-year follow-up.
Results are associational and causality cannot be inferred so replication is needed.
This study highlights the multi-dimensional nature of PTG and demonstrates a salubrious effect of trauma-related gains in personal strength on incident PTSD.
[Show abstract][Hide abstract] ABSTRACT: Veterans of Operations Iraqi Freedom/Enduring Freedom/New Dawn (OEF/OIF/OND) tend not to engage in mental health care. Identifying modifiable factors related to mental health service utilization could facilitate development of interventions to increase utilization. The current study examined the relationship between mental health care utilization and measures of PTSD symptoms, resilience, stigma, beliefs about mental health care, perceived barriers to mental health care, posttraumatic growth and meaning, social support, and personality factors in a sample of 100 OEF/OIF/OND veterans with PTSD symptoms referred to VA mental health care. Participants who received psychotherapy and pharmacotherapy (PP) scored higher on measures of PTSD symptoms, stigma, and adaptive beliefs about mental health treatment, and lower on measures of resilience, postdeployment social support, emotional stability, and conscientiousness, than participants who received no treatment (NT). Participants who received psychotherapy only (PT) scored higher on a measure of PTSD symptoms than NT participants. PT participants scored higher on an emotional stability measure and lower on measures of PTSD symptoms and stigma than PP participants. Multinomial logistic regression including all variables significantly related to treatment utilization indicated that PTSD symptoms and adaptive beliefs about psychotherapy and pharmacotherapy were higher in the PT and PP groups than in the NT group, and concerns about discrimination were higher in the PP group than the NT group. Interventions targeting beliefs about mental health care could increase mental health treatment utilization among OEF/OIF/OND veterans. Concerns about stigma may affect the utilization process differently at different decision points. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
Psychological Trauma Theory Research Practice and Policy 08/2015; DOI:10.1037/tra0000075 · 2.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives
The aim of this study was to evaluate the role of resource-oriented variables such as self-efficacy, locus of control (LOC) and post-traumatic growth (PTG) in predicting treatment response in older adults with post-traumatic stress.Methods
Fifty-eight older adults with subsyndromal or greater severity of war-associated post-traumatic stress disorder (PTSD) symptoms completed a randomized controlled Internet-based cognitive-behavioural therapy (CBT) with immediate and delayed treatment groups. Assessments of PTSD severity and resource-oriented variables of self-efficacy, LOC and PTG were conducted at baseline, post-treatment and at a 6-month follow-up.ResultsResults revealed that pre-treatment scores on measures of internal LOC and PTG predicted PTSD symptom severity at post-treatment, even after controlling for initial PTSD. At a 6-month follow-up, internal LOC continued to predict PTSD symptom severity. In addition, repeated-measures analyses of variance revealed that, relative to older adults with low internal LOC and PTG, older adults with high internal LOC and PTG, respectively, did not differ with respect to initial PTSD severity, but they showed a more pronounced response to treatment.Conclusion
These findings suggest that greater locus of control and post-traumatic growth is associated with greater improvement in PTSD symptoms following Internet-based CBT. Assessment of these constructs may be useful in identifying trauma survivors who are most likely to respond to CBT.Practitioner pointsGreater internal locus of control and post-traumatic growth is associated with greater improvement in PTSD symptoms following Internet-based CBT.Older adults with initial high internal locus of control and post-traumatic growth, respectively, did not differ with respect to initial PTSD severity, but they showed a more pronounced response to treatment.It could be assumed that patients with initial functional appraisals could benefit easier and faster from a trauma-focused cognitive-behavioural therapy compared to individuals with lower internal locus of control and post-traumatic growth
[Show abstract][Hide abstract] ABSTRACT: The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) formally introduced a dissociative subtype of posttraumatic stress disorder (PTSD). This study examined the proportion of U.S. veterans with DSM-5 PTSD that report dissociative symptoms; and compared veterans with PTSD with and without the dissociative subtype and trauma-exposed controls on sociodemographics, clinical characteristics, and quality of life. Multivariable analyses were conducted on a nationally representative sample of 1484 veterans from the National Health and Resilience in Veterans Study (second baseline survey conducted September-October, 2013). Of the 12.0% and 5.2% of veterans who screened positive for lifetime and past-month DSM-5 PTSD, 19.2% and 16.1% screened positive for the dissociative subtype, respectively. Among veterans with PTSD, those with the dissociative subtype reported more severe PTSD symptoms, comorbid depressive and anxiety symptoms, alcohol use problems, and hostility than those without the dissociative subtype. Adjusting for PTSD symptom severity, those with the dissociative subtype continued to report more depression and alcohol use problems. These results underscore the importance of assessing, monitoring, and treating the considerable proportion of veterans with PTSD and dissociative symptoms.
Published by Elsevier Ltd.
Journal of Psychiatric Research 04/2015; 66-67. DOI:10.1016/j.jpsychires.2015.04.017 · 3.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Posttraumatic stress disorder (PTSD) is associated with high medical morbidity, but the nature of this association remains unclear. Among responders to the World Trade Center (WTC) disaster, PTSD is highly comorbid with lower respiratory symptoms (LRS), which cannot be explained by exposure alone. We sought to examine this association longitudinally to establish the direction of the effects and evaluate potential pathways to comorbidity.
18,896 responders (8466 police and 10,430 nontraditional responders) participating in the WTC-Health Program were first evaluated between 2002 and 2010 and assessed again 2.5 years later. LRS were ascertained by medical staff, abnormal pulmonary function by spirometry, and probable WTC-related PTSD with a symptom inventory.
In both groups of responders, initial PTSD (standardized regression coefficient: β = 0.20 and 0.23) and abnormal pulmonary function (β = 0.12 and 0.12) predicted LRS 2.5 years later after controlling for initial LRS and covariates. At follow-up, LRS onset was 2.0 times more likely and remission 1.8 times less likely in responders with initial PTSD than in responders without. Moreover, PTSD mediated, in part, the association between WTC exposures and development of LRS (p < .0001). Initial LRS and abnormal pulmonary function did not consistently predict PTSD onset.
These analyses provide further evidence that PTSD is a risk factor for respiratory symptoms and are consistent with evidence implicating physiological dysregulation associated with PTSD in the development of medical conditions. If these effects are verified experimentally, treatment of PTSD may prove helpful in managing physical and mental health of disaster responders.
Psychosomatic Medicine 04/2015; 77(4). DOI:10.1097/PSY.0000000000000179 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examinedrisk and resilience factors associated with posttraumatic stress symptomatology (PTSS) in an ethno-racially diverse sample of Hawai׳i National Guard members comprised of Native Hawaiians, Filipino Americans, Japanese Americans, and European Americans. In the full sample, identifying as Japanese American and higher scores on measures of perceived social support and psychological resilience were negatively associated with PTSS, while Army Guard (vs. Air Guard) status and stronger family norms against disclosing mental health problems were positively associated with PTSS. Exploratory analyses of ethno-racial subgroups identified different patterns of within and between-group correlates of PTSS. For example, when controlling for other factors, higher psychological resilience scores were negatively associated with PTSS only among Native Hawaiian and European Americans. Overall, results of this study suggest that some risk and resilience factors associated with posttraumatic stress disorder (PTSD) may extend to military populations with high numbers of Filipino American, Japanese American, and Native Hawaiian Veterans. Results further suggest differences in risk and resilience factors unique to specific ethno-racial subgroups.
Published by Elsevier Ireland Ltd.
[Show abstract][Hide abstract] ABSTRACT: Background
Posttraumatic growth (PTG) is increasingly recognized as an important psychosocial phenomenon, but few studies have evaluated the longitudinal course of PTG. This study identified courses of PTG over a 2-year period in a contemporary, nationally representative sample of U.S. military veterans, and examined sociodemographic, military, trauma, medical, and psychosocial predictors of PTG course.Methods
Data were based on a Web-based survey of a nationally representative sample of 1,838 U.S. veterans who reported at least one potentially traumatic event and provided data at two time points (October–December 2011 and September–October 2013).ResultsFive different courses of PTG were identified—Consistently Low (33.6%), Moderately Declining (19.4%), Increasing PTG (16.8%), Dramatically Declining (15.7%), and Consistently High (14.5%). More than half (59.4%) of veterans who reported at least “moderate” PTG maintained that level of PTG 2 years later. Posttraumatic stress disorder symptoms, medical conditions, purpose in life, altruism, gratitude, religiosity, and an active reading lifestyle predicted maintenance or increase in PTG.ConclusionsPTG has a heterogeneous course and is not only common, but can persist over time especially in the presence of posttraumatic stress and certain psychosocial factors. Clinicians and researchers should consider the personal growth that can result from trauma and help trauma survivors find ways to maintain this growth over time.
Depression and Anxiety 04/2015; DOI:10.1002/da.22371 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
To determine mental health service utilization and barriers among female veterans, this study examined the prevalence of U.S. female veterans who identified the U.S. Department of Veterans Affairs (VA) as their main source of health care.
This observational study used data from a nationally representative sample of 1,202 veterans who completed a Web-based survey. The analysis compared sociodemographic and clinical characteristics, mental health service use, and perceived barriers to mental health care among female veterans who do and do not use the VA as their main source of health care and male veterans who mainly use VA health care.
By gender, 23.4% of female veterans and 19.6% of male veterans identified the VA as their main source of health care, which was not significantly different. Compared with male VA patients, women were more likely to be single, younger, and from a racial-ethnic minority group and to screen positive for depression and posttraumatic stress disorder (PTSD), but they were less likely to have a substance use disorder. Compared with female veterans who did not mainly use VA care, female VA patients were more likely to be on a low income, not employed, from racial-ethnic minority groups, and combat veterans, and they were more likely to have a disability, to screen positive for PTSD, and to report poorer mental health-related functioning. There were no group differences in mental health service use, and the most frequently endorsed barriers to using mental health care across veteran groups were "high treatment costs" and "being seen as weak."
These findings highlight the health care needs of female VA service users and support efforts to dispel misconceptions and stigma related to mental health care.
[Show abstract][Hide abstract] ABSTRACT: This study examined risk and resilience factors associated with posttraumatic stress symptomatology (PTSS) in an ethno-racially diverse sample of Hawai’i National Guard members comprised of Native Hawaiians, Filipino Americans, Japanese Americans, and European Americans. In the full sample, identifying as Japanese American and higher scores on measures of perceived social support and psychological resilience were negatively associated with PTSS, while Army Guard (vs. Air Guard) status and stronger family norms against disclosing mental health problems were positively associated with PTSS. Exploratory analyses of ethno-racial subgroups identified different patterns of within and between-group correlates of PTSS. For example, when controlling for other factors, higher psychological resilience scores were negatively associated with PTSS only among Native Hawaiian and European Americans. Overall, results of this study suggest that some risk and resilience factors associated with PTSD may extend to military populations with high numbers of Filipino American, Japanese American, and Native Hawaiian Veterans. Results further suggest differences in risk and resilience factors unique to specific ethno-racial subgroups.
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Posttraumatic stress disorder (PTSD) is a prevalent, chronic and disabling anxiety disorder that may develop following exposure to a traumatic event. There is currently no effective pharmacotherapy for PTSD and therefore the discovery of novel, evidence-based treatments is particularly important. This review of potential novel treatments could act as a catalyst for further drug investigation.
In this review, the authors discuss the heterogeneity of PTSD and why this provides a challenge for discovering effective treatments for this disorder. By searching for the neurobiological systems that are disrupted in individuals with PTSD and their correlation with different symptoms, the authors propose potential pharmacological treatments that could target these symptoms. They discuss drugs such as nabilone, d-cycloserine, nor-BNI, 7,8-dihydroxyflavone and oxytocin (OT) to target systems such as cannabinoids, glutamate, opioids, brain-derived neurotrophic factor and the OT receptor, respectively. While not conclusive, the authors believe that these brain systems include promising targets for drug discovery. Finally, the authors review animal studies, proof-of-concept studies and case studies that support our proposed treatments.
A mechanism-based approach utilizing techniques such as in vivo neuroimaging will allow for the determination of treatments. Due to the heterogeneity of the PTSD phenotype, focusing on symptomology rather than a categorical diagnosis will allow for more personalized treatment. Furthermore, there appears to be a promise in drugs as cognitive enhancers, the use of drug cocktails and novel compounds that target specific pathways linked to the etiology of PTSD.